![]() ![]() Fluoxetine and fluvoxamine are inhibitors of CYP2C19. Fluoxetine, paroxetine, sertraline, citalopram, and escitalopram are inhibitors of CYP2D6. SSRIs are metabolized by and have effects on the cytochrome P450 system. Although infrequent, as with all medications that increase serotonin activity, it is important to be aware of the risk of serotonin syndrome, particularly when prescribing multiple medications that may have serotonergic effects. Coagulopathy also correlates with SSRI use. Citalopram has correlations with a longer QT duration than the other medications in this class. ![]() SSRIs also have the potential to prolong the QT interval, which can lead to fatal arrhythmia, torsade de pointes. Common side effects from SSRIs include sexual dysfunction, sleep disturbances, weight changes, anxiety, dizziness, xerostomia, headache, and gastrointestinal distress. The risk and benefits of initiating SSRI therapy on acutely suicidal patients must be weighed, keeping in mind that depression itself is a large risk factor for suicidality and requires treatment. In 2004, the FDA issued a black box warning for SSRIs and other antidepressant medications due to a possible increased risk of suicidality among pediatric and young adult (up to age 25) populations. Although relatively safer due to their selectiveness for serotonin, SSRIs are not without risks. Increased tolerability compared to other classes of medications make SSRIs first-line options for their indicated uses. This characteristic leads to fewer complaints of side effects such as xerostomia, sedation, constipation, urinary retention, and cognitive impairments. SSRIs have little or no effect on dopamine, norepinephrine, histamine, or acetylcholine (except for paroxetine). The popularity and widespread use of SSRIs is due in part to their relatively fewer side effects than prior commonly used antidepressants such as TCAs and MAOIs.
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